Eighteenth Citizens’ Panel Report

The eighteenth Citizens’ Panel survey was carried out between May 2026 and July 2026.

The survey sought views on Hospital at Home, and organ and tissue donation after death.

A total of 646 survey responses were received, equivalent to a response rate of 60%. This is sufficient to support robust analysis with overall results accurate to ± 3.9%. Key findings are summarised over the following pages. The body of this report sets out findings in more detail, and a profile of survey responses is appended.

Hospital at Home

Key findings

Panel members were asked about their awareness of and views on Hospital at Home. Key findings are summarised below.

Awareness of Hospital at Home was mixed. Just under half of respondents (48%) had not heard of Hospital at Home. Around a third (31%) reported that they had heard of Hospital at Home and understood what it involved, while a further 20% had heard of the service but did not feel they understood it.
The benefits most frequently associated with Hospital at Home were remaining in a familiar environment (86%) and reduced risk of hospital-acquired infections (56%). The most common concern was potential for delay in receiving medical help at home if a patient’s health deteriorated, compared to being treated in hospital (85%).
In terms of helping Hospital at Home to work better for people, the most frequently mentioned factors were: confidence about access to urgent help quickly, if needed (68%), regular communication with healthcare professionals (61%) and information in advance about how Hospital at Home works (55%).
Given the option to choose between Hospital at Home or staying in hospital, Hospital at Home was the most commonly selected option (44%), although respondents were divided and a substantial minority remained unsure (30%). Written comments suggest that support for Hospital at Home is often conditional on clinical suitability, severity of illness, speed of access to urgent care and the availability of family or carer support.
The most common reason for choosing Hospital at Home was the comfort and familiarity of home, and a view that this would support recovery. The most common reasons for choosing a stay in hospital were being confident of access to emergency response, suitability for more acute conditions, and access to professional staff and equipment.

Based on these findings, Healthcare Improvement Scotland makes the following recommendations to NHS Boards. In addition, there is a need to improve awareness and understanding of Hospital at Home at a national level, so recommendation one is also made to the Scottish Government.

Recommendations

The Scottish Government and NHS Boards should provide clear and accessible information about what Hospital at Home is and how the service works. National communication should support wider public awareness and consistent understanding of the service. This should be complemented by local communication from NHS Boards explaining whether Hospital at Home is available in their area, who may be eligible and how local services operate. Communications should explain the potential benefits identified by respondents, including receiving care in familiar surroundings, reduced disruption to daily life and reduced exposure to hospital-acquired infection. This may support informed decision-making and more realistic expectations of the service.
Information for patients, families and the wider public should address common concerns identified in the survey, particularly around access to urgent help, the quality and safety of care provided at home, and communication with healthcare professionals. Clear information and reassurance in these areas may help build confidence in the service.
Assessment for Hospital at Home should take account of the patient’s living arrangements, support network and home circumstances, reflecting respondents’ concerns about the availability of family or carer support. Discussions should recognise that family members or unpaid carers may have differing capacities to provide support. Where relevant, patients and families should receive clear information about what the service would require of the wider household.
Hospital at Home should be presented as an option where it is clinically appropriate, recognising that preferences for receiving acute care at home or staying in hospital vary according to individual needs and circumstances. Referring practitioners should have accurate and up-to-date information about the service available in their area so that they can explain the option and support patients to make an informed choice.

Organ and tissue donation after death

Key findings

Panel members were asked about their views on organ and tissue donation, awareness and understanding of the system in Scotland, and willingness to donate organs and tissue. Key findings are summarised below.

A large majority of respondents feel able to have a conversation with a family member or loved one about their organ and tissue donation decision (85%) and feel that they have enough information to make an informed choice (82%).
Most respondents support the opt-out system for organ and tissue donation in Scotland (76%), and trust the organ and tissue donation system in Scotland (75%).
A large majority of respondents were aware of the opt-out system of organ and tissue donation in Scotland (88%) and understood that this means they may be presumed to be willing to donate unless they have stated otherwise (86%). Fewer respondents said they knew how to register their organ and tissue donation decision (55%).
More than half of respondents (56%) think that a donation may go ahead with families consulted to check their loved ones most recent wishes, and a further 21% think that donation is usually considered only after asking what the family want to happen.
Most respondents think that you do not have to register to be considered as a donor in Scotland (68%), and that families are always asked about a person’s latest views if donation is being considered (60%).
Nearly three quarters of respondents (72%) indicated that they are willing to donate their organs and tissue after death. The majority felt that their family or close friends know what their wishes are regarding organ and tissue donation (73%), and were confident that their wishes would be respected (80%).
Overall, the findings are broadly similar to those from the 2023 Citizens’ Panel survey. Both surveys found high levels of awareness and support for the opt-out system, alongside continuing gaps in people’s understanding of how to register a decision and how the system operates in practice. Small differences between the surveys should be interpreted cautiously, given the separate samples and margins of error.

Recommendations

Based on these findings Healthcare Improvement Scotland makes the following recommendations to Scottish Government and relevant stakeholders.

1. Improve public understanding of the opt-out system. Future communication should explain how the opt-out system works in practice. This should include:

the role of families,
what deemed authorisation means,
when donation may proceed,
legal exclusions,
what safeguards are in place,
how to record a decision, and
the difference between opting in and opting out.

Information should use clear and accessible language and should help address the common areas of confusion identified in the findings.

2. Support people to record and share their decision. Communications should continue to encourage people to record their decision and discuss it with family members or loved ones. This should apply whether a person wants to donate or has chosen to opt-out. Clearer information is also needed on how to register a decision, where it is recorded and how it can be reviewed or changed over time. Communications should also acknowledge that these conversations can be sensitive and emotionally difficult for some people and provide practical support to help people discuss their wishes. Communications should explain the benefits of recording a decision even where an individual supports donation under the opt-out system.

3. Address uncertainty about eligibility. Future information should address common misunderstandings about age, health conditions and eligibility to donate. Messages should make clear that suitability for donation is assessed at the relevant time. Information should help reassure people that age, previous illness or existing medical conditions do not automatically prevent donation.

4. Refresh public awareness activity. Consideration should be given to renewed public awareness activity across a range of communication channels. This could include television, radio, NHS communications, social media and other public information routes. Regular reminders may help people review their decision, update their preferences where necessary and speak to family members about their wishes.

5. Build trust through reassurance and real-life examples. Public communications should provide reassurance about consent, dignity, personal choice and the safeguards that underpin the organ and tissue donation system. This may help people understand the benefits of donation and make an informed decision. Communications should also be sensitive to the different cultural, religious and personal beliefs that may influence people’s views on donation.

6. Continue to monitor awareness and action. Future research should continue to measure awareness and understanding of organ and tissue donation and the opt-out system. It should also look at practical behaviours, such as recording a decision, discussing wishes with family members, and confidence that wishes will be respected. This would help assess whether awareness is leading to informed decision-making and action.